How superbug spreads among regional hospitals: A domino effect

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Washington, DC, July 30, 2013

A moderate increase in vancomycin-resistant enterococci (VRE) at one hospital can lead to a nearly 3 percent increase in VRE in every other hospital in that county, according to a study in the August issue of the American
Journal of Infection Control, the official publication of the Association for Professionals in Infection Control and Epidemiology (APIC).

VRE is one of the most common bacteria that cause infections in healthcare facilities.

Researchers
from the Johns Hopkins Bloomberg School of Public Health, Pittsburgh Supercomputing Center (PSC), University of Pittsburgh, and University of California, Irvine created the Regional Healthcare Ecosystem Analyst (RHEA), a mathematical and computational model, to track the movement between hospitals of
VRE-colonized patients (patients carrying the organism but not yet infected) over the course of a year in Orange County, Calif. Using this model, they were able to assess how increases or decreases in one hospital's VRE affected neighboring hospitals.

Not only did the investigators find that
a moderate increase in VRE at any one hospital caused an average 2.8 percent increase throughout the county (range: 0 percent to 61 percent), they also discovered that hospitals in the most populated area of the county had an even greater likelihood of spreading VRE throughout the network. Additional
modeling identified a potential for "free-riders"—hospitals that will experience decreases in VRE incidence due to other hospitals' infection control efforts without initiating any infection prevention measures of their own.

The study points to the underutilization of patient-sharing
data between regional hospitals, the importance of inter-hospital communication and collaboration in decreasing VRE rates, and the scope of variables that must be considered in analyzing the outcome of any one infection prevention initiative.

"Our study demonstrates how extensive patient sharing
among different hospitals in a single region substantially influences VRE burden in those hospitals," states Bruce Y. Lee, MD, MBA, lead author and Associate Professor of International Health and Director of Operations Research, International Vaccine Access Center, at the Johns Hopkins Bloomberg School
of Public Health. "Lowering barriers to cooperation and collaboration among hospitals, for example, developing regional control programs, coordinating VRE control campaigns, and performing regional research studies, could favorably influence regional VRE prevalence."

Vancomycin-resistant enterococci
are resistant to vancomycin, the drug often used to treat serious infections for which other medicines may not work. VRE can live in the human intestines and female genital tract without causing disease. However, sometimes they can cause infections of the urinary tract, the bloodstream, or of wounds
associated with catheters or surgical procedures. There are an estimated 20-85,000 cases of VRE each year in U.S. hospitals.

About American Journal of Infection ControlAJIC: American Journal of Infection Control (www.ajicjournal.org)
covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJICfor peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC
is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier,
AJIC is
included in MEDLINE and CINAHL.

About APICAPIC's mission is to create a safer world through prevention of infection. The association's more than 14,000 members direct infection prevention programs that save lives and improve the bottom
line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org.
Follow APIC on Twitter: http://twitter.com/apicand Facebook: www.facebook.com/APICInfectionPreventionandYou.

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